The elephant in the room: Facilitating conversations about advanced cancer between patients and their spouses.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 233-233 ◽  
Author(s):  
Laura S. Porter ◽  
Laura FIsh ◽  
Hope Elizabeth Uronis ◽  
Yousuf Zafar ◽  
Karen E. Steinhauser
Keyword(s):  
Relationship Satisfaction ◽  
End Of Life ◽  
Communication Skills ◽  
Emotional Support ◽  
Intimate Relationships ◽  
Qualitative Content Analysis ◽  
Skills Training ◽  
Advanced Illness ◽  
Emotional Intimacy ◽  
Quantitative Analyses

233 Background: Interventions to enhance couples’ communication about cancer-related issues can lead to benefits for patients, spouses, and their relationships. We recently conducted a pilot study testing a couples communication skills training (CCST) intervention targeted to couples in which one partner had advanced GI cancer, a population who may need particular help addressing difficult and emotionally-laden topics related to life-limiting illness. Results of quantitative analyses suggested that the intervention was effective in improving relationship satisfaction for these couples. The objective of the current study was to analyze intervention session conversation content to identify themes that couples addressed spontaneously, with the ultimate goal of determining whether an intervention that more specifically guides couples to discuss issues related to end of life and the life-limiting nature of the patient’s illness would be acceptable. Methods: 12 couples (10 male and 2 female patients and their spouses) completed the 6 session CCST intervention which provided training in communication skills for sharing thoughts and feelings and making decisions, and gave couples the opportunity to use these skills to discuss cancer-related issues of their choosing. We conducted qualitative content analysis of the 72 audio-recorded sessions, and coded common and recurrent topics raised by patients and spouses. In addition to identifying breadth of topics, we used theme frequency as an initial gauge of theme importance and acceptability. Results: The most common themes identified were prognosis, treatment, emotional intimacy, completion, spouse’s life after the death of the patient, roles, communication, sublimating needs, emotional support, and family. These represent themes previously identified as important to patients at end of life, as well as themes unique to dyads in intimate relationships. Conclusions: These findings support the feasibility of conducting an intervention that combines training in communication skills with guidance for using these skills to discuss topics that are potentially most meaningful to couples facing advanced illness.

11 Filling the void: preparing future junior doctors for challenging conversations

2018 ◽  
Vol 8 (3) ◽  
pp. 363.3-364
Author(s):  
Hannah Costelloe ◽  
Alice Copley ◽  
Andrew Greenhalgh ◽  
Andrew Foster ◽  
Pratik Solanki
Keyword(s):  
Palliative Care ◽  
Medical Education ◽  
Medical Students ◽  
Small Group ◽  
End Of Life ◽  
Communication Skills ◽  
Skills Training ◽  
Junior Doctors ◽  
List Type ◽  
The Impact

Evidence demonstrates that medical students have limited experience in developing ‘higher-order communication skills’ (Kaufman et al. 2000). Anecdotally many do not feel confident in their ability to conduct difficult conversations often due to a lack of exposure to such scenarios in practice or a pervasive notion that these scenarios are inappropriate for students and beyond the scope of a junior doctor’s role and thus not a focus of curriculums (Noble et al. 2007). There is however a correlation between level of clinical experience and improved confidence for medical students (Morgan and Cleave-Hogg 2002).We surveyed a group of final year medical students to assess their confidence using a 10-point Likert scale in tackling common palliative and end of life care scenarios. Our intervention comprised a study day of 10 practical small-group teaching simulation and OSCE-style stations designed to provide exposure to common experiences in a controlled setting. We reassessed the confidence of students after delivery and objectively explored the impact of the day by asking participants to complete a validated assessment before and after the course. All results showed significant improvement on t-testing: confidence in end of life communication in an OSCE setting improved by 42.2% and assessment marks improved by 24.7% (p=0.039).Palliative care is an area in which students approaching the end of undergraduate training feel underprepared. Our findings demonstrate that small group sessions improve confidence by facilitating communication practice in a controlled environment and providing crucial exposure to common palliative care scenarios they will face as doctors.References. Kaufman D, Laidlaw T, Macleod H. Communication skills in medical school: Exposure confidence and performance. Academic Medicine [online] 2000;75(10):S90–S92. Available at https://journals.lww.com/academicmedicine/Fulltext/2000/10001/Communication_Skills_in_Medical_School__Exposure.29.aspx [Accessed: 30 May 2018]. Morgan P, Cleave-Hogg D. Comparison between medical students’ experience confidence and competence. Medical Education [online] 2002;36(6):534–539. Available at https://doi.org/10.1046/j.1365-2923.2002.01228.x [Accessed: 30 May 2018]. Noble L, Kubacki A, Martin J, Lloyd M. The effect of professional skills training on patient-centredness and confidence in communicating with patients. Medical Education [online] 2007;41(5):432–440. Available at https://doi.org/10.1111/j.1365-2929.2007.02704.x [Accessed: 30 May 2018]

scholarly journals The effectiveness of communication-skills training interventions in end-of-life noncancer care in acute hospital-based services: A systematic review

2015 ◽  
Vol 14 (4) ◽  
pp. 433-444 ◽  
Author(s):  
Laura Lord ◽  
David Clark-Carter ◽  
Amy Grove
Keyword(s):  
Systematic Review ◽  
End Of Life ◽  
Communication Skills ◽  
Self Efficacy ◽  
Skills Training ◽  
Communication Skills Training ◽  
Training Interventions ◽  
Staff Behavior ◽  
The Impact ◽  
End Of Life Communication

AbstractObjective:A systematic review was conducted in order to explore the effectiveness of communication-skills training interventions in end-of-life care with noncancer acute-based healthcare staff.Method:Articles were included if they (1) focused on communication-skills training in end-of-life/palliative care for noncancer acute-based staff and (2) reported an outcome related to behavior change with regard to communication. Sixteen online databases were searched, which resulted in 4,038 potential articles. Screening of titles left 393 articles that met the inclusion criteria. Abstracts (n = 346) and full-text articles (n = 47) were reviewed, leaving 10 papers that met the criteria for our review. All articles explored the effect of communication-skills training on aspects of staff behavior; one study measured the effect on self-efficacy, another explored the impact on knowledge and competence, and another measured comfort levels in discussing the end of life with patients/families. Seven studies measured a number of outcomes, including confidence, attitude, preparedness, stress, and communication skills.Results:Few studies have focused on end-of-life communication-skills training in noncancer acute-based services. Those that do have report positive effects on staff behavior with regard to communication about the end of life with patients and families. The studies varied in terms of the population studied and the health services involved, and they scored only moderately or weakly on quality. It is a challenge to draw a definite conclusion about the effectiveness of training interventions in end-of-life communication because of this. However, the findings from our review demonstrate the potential effectiveness of a range of training interventions with healthcare professionals on confidence, attitude, self-efficacy, and communication skills.Significance of results:Further research is needed to fully explore the effectiveness of existing training interventions in this population, and evidence using objective measures is particularly needed. Ideally, randomized controlled trials or studies using control groups and longer follow-ups are needed to test the effectiveness of interventions.

scholarly journals Discussing Death, Dying, and End-of-Life Goals of Care: A Communication Skills Training Module for Oncology Nurses

2015 ◽  
Vol 19 (6) ◽  
pp. 697-702 ◽  
Author(s):  
Nessa Coyle ◽  
Ruth Manna ◽  
Megan Shen ◽  
Smita Banerjee ◽  
Stacey Penn ◽  
...  
Keyword(s):  
End Of Life ◽  
Communication Skills ◽  
Skills Training ◽  
Oncology Nurses ◽  
Life Goals ◽  
Communication Skills Training ◽  
Training Module ◽  
Goals Of Care

Learning by (video) example: a randomized study of communication skills training for end-of-life and error disclosure family care conferences

2016 ◽  
Vol 212 (5) ◽  
pp. 996-1004 ◽  
Author(s):  
Connie C. Schmitz ◽  
Jonathan P. Braman ◽  
Norman Turner ◽  
Stephanie Heller ◽  
David M. Radosevich ◽  
...  
Keyword(s):  
End Of Life ◽  
Communication Skills ◽  
Randomized Study ◽  
Family Care ◽  
Skills Training ◽  
Communication Skills Training ◽  
Error Disclosure

Evaluation of a novel individualised communication-skills training intervention to improve doctors’ confidence and skills in end-of-life communication

2012 ◽  
Vol 27 (3) ◽  
pp. 236-243 ◽  
Author(s):  
Josephine M Clayton ◽  
Phyllis N Butow ◽  
Amy Waters ◽  
Rebekah C Laidsaar-Powell ◽  
Angela O’Brien ◽  
...  
Keyword(s):  
End Of Life ◽  
Communication Skills ◽  
Skills Training ◽  
Training Intervention ◽  
Communication Skills Training ◽  
End Of Life Communication

Development and preliminary evaluation of communication skills training program for oncologists based on patient preferences for communicating bad news

2013 ◽  
Vol 12 (5) ◽  
pp. 379-386 ◽  
Author(s):  
Maiko Fujimori ◽  
Yuki Shirai ◽  
Mariko Asai ◽  
Nobuya Akizuki ◽  
Noriyuki Katsumata ◽  
...  
Keyword(s):  
Communication Skills ◽  
Emotional Support ◽  
Patient Preferences ◽  
Skills Training ◽  
Bad News ◽  
Simulated Patients ◽  
Preliminary Evaluation ◽  
Communication Skills Training ◽  
Additional Information ◽  
Didactic Lecture

AbstractObjective:The purposes of this study were to develop a communication skills training (CST) workshop program based on patient preferences, and to evaluate preliminary feasibility of the CST program on the objective performances of physicians and the subjective ratings of their confidence about the communication with patients at the pre- and post-CST.Methods:The CST program was developed, based on the previous surveys on patient preferences (setting up the supporting environment of the interview, making consideration for how to deliver bad news, discussing about additional information, and provision of reassurance and emotional support) and addressing the patient's emotion with empathic responses, and stressing the oncologists' emotional support. The program was participants' centered approach, consisted a didactic lecture, role plays with simulated patients, discussions and an ice-breaking; a total of 2-days. To evaluate feasibility of the newly developed CST program, oncologists who participated it were assessed their communication performances (behaviors and utterances) during simulated consultation at the pre- and post-CST. Participants also rated their confidence communicating with patients at the pre-, post-, and 3-months after CST, burnout at pre and 3 months after CST, and the helpfulness of the program at post-CST.Results:Sixteen oncologists attended a newly developed CST. A comparison of pre-post measures showed improvement of oncologists' communication performances, especially skills of emotional support and consideration for how to deliver information. Their confidence in communicating bad news was rated higher score at post-CST than at pre-CST and was persisted at 3-months after the CST. Emotional exhaustion scores decreased at 3-months after CST. In addition, oncologists rated high satisfaction with all components of the program.Significance of results:This pilot study suggests that the newly developed CST program based on patient preferences seemed feasible and potentially effective on improving oncologists' communication behaviors what patients prefer and confidence in communicating with patients.

Improving Communication Skills in Health Care

2013 ◽  
Vol 20 (3) ◽  
pp. 109-117
Author(s):  
Lynda Katz Wilner ◽  
Marjorie Feinstein-Whittaker
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Communication Skills ◽  
Health Care Professionals ◽  
Skills Training ◽  
International Medical Graduate ◽  
Medical Graduate ◽  
Health Care Environment ◽  
Medical Interpreters ◽  
Accent Modification

Hospital reimbursements are linked to patient satisfaction surveys, which are directly related to interpersonal communication between provider and patient. In today’s health care environment, interactions are challenged by diversity — Limited English proficient (LEP) patients, medical interpreters, International Medical Graduate (IMG) physicians, nurses, and support staff. Accent modification training for health care professionals can improve patient satisfaction and reduce adverse events. Surveys were conducted with medical interpreters and trainers of medical interpreting programs to determine the existence and support for communication skills training, particularly accent modification, for interpreters and non-native English speaking medical professionals. Results of preliminary surveys suggest the need for these comprehensive services. 60.8% believed a heavy accent, poor diction, or a different dialect contributed to medical errors or miscommunication by a moderate to significant degree. Communication programs should also include cultural competency training to optimize patient care outcomes. Examples of strategies for training are included.

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